Saturday, November 2, 2013

I don’t  blog much as I don’t find much time for it but I figured running 50 miles last weekend with type I diabetes and actually doing well at it deserves little bit of a write up. The intention of this blog is to detail my diabetes control before and during the race and not get into details on training or racing ultramarathons. This is about Fall 50 mile race in door county, Wisconsin.
As most T1’s I take care of my nutrition 24/7 but week before the major race I do take special attention to my nutrition. I limit my intake to simple carbs and low fat diet which usually warrants increased insulin dosages.  I don’t do much of a taper but this change to simple carbs and quantity does increase my insulin dosage about 25-30%.
I am not a pumper. I take Lantus for my basal needs and Humalog for fast acting needs.

Day before the race: Lantus is the same dosage. I never ever cut my basal insulin. Dinner is very early and is a large amount of very simple carbs and very little protein and fat. I bolus 35-45% more insulin than the meal itself. 2 hours post meal I check and keep checking often. For the next 5-6 hours I maintain the blood sugars in 80-140 range by drinking Gatorade or another simple sugar/electrolyte drink. The goal is to fill up the storage tanks for the race but not to rebound and shoot too high in the middle of the night. I can easily go through 20-25 strips in this time frame.

Morning of: Wake up at least 3.5 hours before the start. Normal breakfast. I eat the same breakfast every day,  Kashi cereal (high protein), skim milk and banana. If my blood sugar is higher than normal when I wake up I will take more insulin with breakfast. If it's normal (80-120) I still go 1-2 units over. This morning I was on target at 110. Not too worried about increasing dosage as nerves will make it go high anyway. I also like to be little on the low side about 30 min before so I can have my final solid food like the Cliff bar just before the race starts. Adrenaline takes care of the final spike few minute before the race

This race my blood sugar was @110 - 30 min before the race so I had about ½ cliff bar (22 carbs) and was ready to roll (just about 3 hours after my Humalog dosage). In ultra you run in aerobic zone so you are much more sensitive to insulin and you cannot count on increased glucose due to liver dumps you get in shorter racing.

 My staple during the race is a GU brew. I mix it so I get about 36 carbs per bottle (20 oz). Drink is very ph neutral so it keeps my tummy very happy :)
I went through my 1st bottle in 11 miles and got the replacement bottle. I also had one GU gel (23g) at about  50 min into the race.

Next 10 miles were tough hilly ones. I went through it with one more Gel (23g) but could not stomach entire GU bottle until I met my wife at mile 23. This is the 1st time we checked my BG and it was 89 so I finished that 2nd GU bottle very quickly and replaced it with another one. It was lot easier to drink it standing than running. I was running low and I knew it but could not force myself to intake more at this time. Also, I heard I might be in the top 10 in the race at this point so little bit of adrenaline kicked in.

At mile 25 I had another GU and kept slowly working on my 3rd GU bottle.  At mile 28 I had my 1st cup of water. It was a cool day so water was not needed as long as I managed to stomach GU brew as planned.
Mile 30. I finally met my wife again and we checked my blood sugar. It was 88 so not too bad but still way too low. My stomach was rough and at this point I could not stomach any more immediate liquids or gels so Cliff shots were perfect. Needed something little more solid…30 carbs total. Also, I replaced my GU brew bottle which was almost completed with a new one. I also learned that I am in top 7 and some of the leaders are fading.

Next 10 miles were a blur. I think I had one or two GU gels and ended passing few people. It was fun and I felt good but did not work on my GU brew as much as I needed to. Finally, I met my wife at mile 41. BG again was @ 88. At this point I dropped my almost finished GU bottle, had some more Cliff shots as I needed some more 'solid' fuel. It was going to be all balls out to the finish. I knew that the pain will set in and my blood sugars will rise quickly. This comes from experience…pain always makes me go high…fight or flight reaction…

Last few miles I had to fight demons other than diabetes…I trusted my body as I knew from my training how it responds to pressure and pain. I’ve ran many races an did lots of training at this intensity to know what my body will do and that is we will spike up, liver has that secret stash. I new I was going into this stage 'healthy' and I have some margin to give before performance starts to suffer or I become unsafe.
My worry at this point is that I did not know where my competition was and running alone was very mentally tough. It is illegal for people to tell you where you are but I heard I was in the 4th place. 4 miles before finish I gave up mentally. I pushed as hard as I could but it was not enough. I finished 4th and 4 minutes behind  the 3rd place finisher. The victory goes to diabetes management, final blood sugar 110. About 250g Ca intake during the race and my personal 50 mile best….6 hours 25 minutes.

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